Provider Demographics
NPI:1215351515
Name:HETHCOCK, JAMIE LYNN ELIZABETH (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:JAMIE LYNN
Middle Name:ELIZABETH
Last Name:HETHCOCK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JAMIE LYNN
Other - Middle Name:ELIZABETH
Other - Last Name:OPPERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:PO BOX 1921
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-1921
Mailing Address - Country:US
Mailing Address - Phone:253-334-2646
Mailing Address - Fax:
Practice Address - Street 1:9881 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2805
Practice Address - Country:US
Practice Address - Phone:253-753-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60297806224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant